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The first thing out of the woman’s mouth was: “We just didn’t notice it.”

She was speaking about her daughter, who had been sent to the emergency department for a medical
clearance before she was admitted to a psychiatric hospital for anorexia.

This was the family’s first venture into the psychiatric world, and all of them were doing their
best at shouldering this sudden change in their lives.

The mother explained that her 15-year-old daughter had been successful, vibrant and active
before becoming withdrawn, listless and painfully thin.

She said the insidious onset of this change had been lost on both her and her ex-husband. She
knew her daughter was dieting. She always had.

She also knew that the divorce was difficult for all of them.

But it wasn’t until a recent trip to the ocean that the mother knew her daughter needed help.
She said she had been scanning the beach for her daughter and saw a solitary girl in the surf.

The mom said to herself: “Someone should feed that poor girl.

”Then she saw that it was her daughter. On the long drive home, she wondered how she could have
let this happen.When the teenager was brought to the emergency department, she was 5 foot 4 and
weighed 92 pounds — skin and bones.Her vital signs showed that both her blood pressure and heart
rate were low.

She was weak and had classic physical findings consistent with the suspected diagnosis of
anorexia nervosa.

She had scrapes and redness along the back of her fingers on her right hand — telltale signs of
self-induced vomiting.

She also had fine, thin, soft hair growing on her shoulders and chest. The condition is called
lanugo, and it is caused by the body’s efforts to stay warm without body fat.

Her skin was dry, and she had clinical signs of dehydration with poor skin elasticity and dry
mucous membranes.

During the exam, she lay with her head in her mother’s lap, rarely opening her eyes. She was
unwilling or unable to give us any further information. We could not tell whether she was
despondent or too weak to participate.

Either way, she clearly needed help.We also found some disturbing things in her lab work.

Her potassium level was low, she was moderately dehydrated and her kidney function was starting
to decline.

The teen’s EKG showed signs of electrolyte abnormalities as well as abnormalities in how her
heart conducted electricity.

She had the potential to develop a life-threatening rhythm.The tragic part of treating patients
with anorexia in the emergency department is realizing they are the “lucky ones,” those who
actually seek — or are brought in for — medical treatment.

Although eating disorders affect about 1 percent of the population — the majority of them young
women — few ever connect with the mental-health system.

This young woman’s physiologic abnormalities were treated and improved rapidly. When I visited
her two days later in the hospital, she remained withdrawn and quiet, but there was at least a
glimmer of hope in her mom’s eyes.

My thanks to psychologist Laura Hill, an eating-disorder specialist, for her assistance with
this column.

Dr. Diane Gorgas is an emergency physician at the Wexner Medical Center at Ohio State
University.